A report by The Audit Office informs that most people in the United Kingdom are dying in hospital – even though the majority would prefer to die at home.

The Audit Office explains that of the half-a-million people who die each year in England, over 66% are over the age of 75. Most deaths take place in an acute hospital, usually after a period of chronic illness, such as cancer, stroke, heart disease, neurological disease, dementia or heart disease.

Whether a patient gets his/her wish – dying at home – depends greatly on age, geographical location and most significantly, his/her condition, the report states.

The aim of ‘end of life care’ is to support the patient who is approaching the end of his/her life as well as possible. A large number and a wide range of staff are involved in end of life care – doctors, nurses, allied health professionals and social workers. According to the report, the exact number of people involved in this type of care is unknown.

Within the area of end of life care is palliative care. Palliative care is delivered by health and social care staff who are specialized in pain management as well as other symptoms – they also provide psychological, social and spiritual support.

The report stresses that the provision of end of life care services has become progressively more complex. As people are living longer, the incidence of frailty and multiple conditions in elderly patients grows. Consequently, those who are nearing death need a combination of health and social care services provided in the community, hospitals, care homes, and/or hospices. Family members, volunteers, and close friends also provide care.

In 2006-2007 PCTs (primary care trusts) spent approximately £245 million in England on specialist palliative care services. According to the Department of Health, the total annual overall cost of end of life care to the National Health Service (NHS) and social care services is measured in billions of pounds. The report estimates that the yearly cost to the NHS and social care services of providing care for cancer patients alone during their last 12 months of life is £1.8 billion (27% of deaths).

According to the report, the Department of Health accepts that end of life care within the NHS and social care services has not had the priority it should have – the Department emphasises that over recent years it has been working on addressing this.

Following a two-year consultation, the Department of Health published its End of Life Care Strategy, aimed at improving the provision of care for all adults who are approaching the end of their lives – this includes support for their loved ones and carers. The End of Life Care Strategy focuses on:

— better provision of community services by, e.g. making rapid response community nursing services available everywhere 24 hours a day seven days a week, and improving coordination of care between local authorities and PCTs;

— equipping health and social care staff at all levels with the necessary skills to communicate with, and deliver care to people approaching the end of life, and their carers; and

— developing specialist palliative care outreach services by encouraging PCTs and hospices to work together to provide appropriate support to all adults in the community, regardless of their condition.

The Department of Health believes that the implementation of its End of Life Care Strategy will reduce the number of improper hospital admissions and allow more patients to end their days in the place of their choice. An extra £286 million over 2009-10 and 2010-11 has been earmarked for this purpose.

According to research, between 56% and 74% of people would prefer to die at home. However, this proportion falls when death looms closer and people wish for more extensive support, such as from a hospice. According to 2006 mortality statistics, only 35% of people die at home or in a care home.

58% of people die in hospital – this is a national average which can vary from 46% to 77%, depending on which part of the country.

— Cancer patients are more likely to die at home
— Dementia patients mostly die in care homes
— Heart disease and pulmonary disease patients mostly die in hospital

There are many people who die in hospital for clinical reasons, many of whom chose hospital as their preferred place of care.

The report informs that a lack of prompt access to services in the community raises the number of people who are approaching the end of their life being unnecessarily hospitalized. “The absence of 24 hour response services and timely access to advice and medication leads to unplanned admissions. In addition, information on patients is not always captured or shared effectively between the different agencies involved in delivering care. This can lead to Do Not Attempt Resuscitation orders not being known or recognised to providers such as out of hours GPs and the ambulance service, resulting in inappropriate admissions to hospitals,” the report states.

According to the report, the proportion of care home residents who end up dying in hospital could be significantly reduced. One quarter of care home residents currently die in a hospital – these proportions vary considerably between care homes, ranging from 0% to 100%.

The report mentions that one Primary Care Trust could have increased the number of residents dying in care homes from 61% to 80% if there had been more support and advice provided to those care homes.

Independent and NHS Hospices – “Independent hospices have an important role in the delivery of end of life care services, both in inpatient care and increasingly in day care and in services in care homes and peoples’ homes. Independent hospices currently provide around 2,150 inpatient beds, compared to 450 provided by NHS hospices. Although traditionally focused on cancer, hospices are also increasingly offering services to people with other conditions. Whilst the proportion of non-cancer patients receiving hospice services is low, it is growing,” the report informs.

According to the report, the National Health Services and Social Care Services are not meeting even the basic needs of many people approaching the end of their life. It quotes a Healthcare Commission study which indicated that people who are approaching the end of their life “are not always afforded the dignity and respect they deserve”. The report says it also identified a similar picture – standard of hospital care and social service provision was disappointing, and care plans for patients had not been drawn up and agreed, causing unnecessary stress for people during the end of their life. This sad state of affairs also causes unnecessary stress for loved ones and those caring for a dying person.

The report covers several more areas

— Click here to read the EXECUTIVE SUMMARY OF THE REPORT
— Click here to read the FULL REPORT

Source – The National Audit Office

Written by Christian Nordqvist